The first treatment is in the books, feeling pretty good, although Psa jumped up from 19 to 63 in three weeks, hopefully Lu 177 will bring that down and slow cancer progression, well I have a interesting delema, I have the doctor thats providing the treatment stating to discontinue the xtandi I am currently taking, based on the lack data showing its effectiveness to express PSMA and benefit my treatment with Lu177. Yes I have read all the links, and understand the german sciencentist are more advanced in the treatment drug Lu 177 and they prescribe xtandi sometimes to show more espession to achieve better clinical outcomes. That being said, I have one birdie onc saying stop, and another saying go. The forum is my third opinion. When I broached the subject with the oncs assistant, and she stated, as she reviewed my scans your cancer is expressing adaquate already, therefore discontinue current regime. Namely, xtandi, and the doctor agrees. Very grateful for this forum, thankyou in advance.
Two Docs two opinions. This isnt che... - Prostate Cancer N...
Two Docs two opinions. This isnt checkers this is chess.
Here's my opinion. There seems to be a number of recent trials that show combined therapies to be more effective than individual ones in sequence. To me this makes sense, since PCa is heterogeneous. Even without increasing expression of PSMA, it makes sense to attack all forms of the cancer simultaneously. This would prevent repopulation of treated sites with other forms of PCa.
The only argument against combined therapy is increased toxicity from side effects, which haven't been tested for in a trial. I figure that the side effects can be watched for and managed. I suppose the fear of some doctors might be that if a side effect arose from combined therapies, it might cause you to stop the primary therapy, since the cause could be either treatment.
Re-population is the 64 million dollar question. How do we know if it will occur in a given individual and how can we prevent it. Thoughts I have had for over a year now that have been magnified by others experiences.
I am gonna get both on the horn and tell them I am conflicted. Doc A. What do you base your opinion on.
Only the doc telling me to discontinue has reviewed my recent psma scan.
This isn’t a popularity contest. Only someone who looks at both your PSMA PET and your FDG pet is qualified to make a recommendation.
I agree that only by reviewing both scans can a trained doctor judge the overlap of PSMA and non-PSMA expressing cells. Hopefully both MOs are doing that.
I think the question is whether to continue Xtandi during Lu-PSMA treatment based on a hypothesis of combined benefit.
The hypothesis is that enzalutamide will increase PSMA expression temporarily.
Yes, as I’ve understood it from my limited reads, “temporarily” is the key word here.
If I understand correctly, there’s a brief window of time towards the beginning of an ENZ protocol that increases PSMA, but then the ENZ will begin to suppress the expression.
As always, I could have this one wrong.
Yes, I agree it is a short-lived effect -- after a month or two it decreases PSMA expression.
Ok, now I have more ammo. Thankyou.
I always value your opinion, I believe your saying, dance with the one who brought you.
Reading this with the hope/anticipation that my husband will have the same, difficult choice in the near future.
Xtandi was barely tolerable for him and the side effects stayed. I also feel that Xtandi might mask the true results of the Lutetium.
On the other hand, the Germans know their stuff. Maybe you could consult the lady doctor from India for her opinion on restarting Xtandi. If all else fails go with what TA recommends.
Funny, you mention masking that was my thought as well. Hope hope grumpy gets lu 177
From previous posts it seem Dr. Ishita Sen offers opinion even if you are not a patient of hers.You could enter lu 177 in the search box here as the topic of Enzi has been brought up in previous posts regarding lu 177 or you could email Dr. Ishita Sen maybe:
She is currently the Director and Head of the Department of Nuclear Medicine & Molecular Imaging at FMRI Gurgaon and reachable on dr.ishitasen@nuclearmedicinetherapy.in for a free consult.
I will ask her opinion shes on the front line.
I'm rootin for you man. Lu177 could give you a long, long remission. Like to see you go into it with confidence.
Absolutely i just want to make sure I receive the best treament available. No regrets. Then when my time does come, I will smile.
Were you able to get an opinion from Dr. Sen and what was you final decision on restarting Xtandi?
How are you doing now?
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